Volunteer Application -BLaCI

Volunteer Application Form
Thank you for your interest in volunteering with Balanced Life A Community Initiative Inc. (BLACI). Our volunteers play an important role in helping us promote wellness, education, community engagement, and youth empowerment.
Name

PrefixFirst NameLast Name
Birth Date

MonthDayYear
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name & Number:
If under 18 years of age. Parent's name and number:
In which areas would you like to volunteer?
If other, what area of interest:
Do you have any volunteering experience? If yes, please describe.
Select your available days
From

Hour Minutes

AM/PM Option
To

Hour Minutes

AM/PM Option
Additional notes about your schedule
Volunteer Expectations
As a volunteer with BLACI, I agree to:
- Support the mission and values of the organization.
- Treat all participants, volunteers, staff, vendors, and community members with respect.
- Follow all safety guidelines and instructions.
- Maintain a positive and professional attitude while representing BLACI.
- Report any concerns, incidents, injuries, or unsafe conditions immediately.
- Refrain from discrimination, harassment, or inappropriate conduct.
Photo & Media ReleaseI grant Balanced Life A Community Initiative Inc. permission to photograph, record, and use images, video, audio, and testimonials of me for educational, promotional, social media, grant reporting, and organizational purposes without compensation.
Liability Waiver
I understand that volunteer activities may involve certain risks, including but not limited to physical activity, lifting, outdoor activities, interaction with the public, and participation in community events.

I voluntarily assume these risks and agree to release, hold harmless, and discharge Balanced Life A Community Initiative Inc., its directors, officers, volunteers, employees, sponsors, and partners from liability for injuries, damages, or losses that may occur while participating in volunteer activities, except where prohibited by law.
Background Check Authorization (If Applicable)
Some volunteer positions may require a background check, particularly those involving direct interaction with children or vulnerable populations.
- I understand that a background check may be required for certain volunteer roles.
Initials
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Consent (For Volunteers Under 18)I give permission for my child to volunteer with Balanced Life A Community Initiative Inc.Parent/Guardian Name:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Organization Use Only
Volunteer Role Assigned:

Start Date: ______________________

Background Check Completed (if required):

☐ Yes ☐ No ☐ N/A

Staff/Coordinator Initials: _____________
Should be Empty:

Volunteer Application Form